Aims There is good evidence showing that inactivity and walking minimal steps/day increase the ri... more Aims There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality. Methods and results We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81–0.91; P < 0.001], wh...
Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespect... more Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespective of their order and specifics of religious practices. The aim of this study was to assess the cardiac risk factors in Coptic priests and monks and their impact on post-acute COVID-19. Methods: Of 1519 clergy, participating in the COVID-19-Clergy study, serving in Europe and Egypt, 257 had the infection and were included in this analysis. Clergy were divided into priests (n=204) and monks (n=53). Participants&#39; demographic indices, cardiovascular risk factors, management details and post-acute COVID-19 duration were assessed. The impact of geographic differences of life style were also analysed. Results: Priests were more obese (p=0.001), had more type 2 diabetes (DM) (p=0.001), arterial hypertension (AH) (p&lt;0.001), dyslipidemia (p=0.001) and lower prevalence of infection (p&lt;0.001) compared to monks. Their symptoms&#39; duration was more prolonged (p&lt;0.001), had frequent post-acute COVID (p&lt;0.001) and had greater need for hospital treatment (p=0.04). In a sub-analysis, priests serving in Europe had higher prevalence of AH, DM, obesity, CHD, dyslipidemia, longer symptoms duration and more frequent post-acute COVID compared to monks
Left atrial compliance predicts limited exercise in patients with HFpEF and right ventricular dys... more Left atrial compliance predicts limited exercise in patients with HFpEF and right ventricular dysfunction
Background and AimThe aim of this study was to assess the nature of myocardial dysfunction in the... more Background and AimThe aim of this study was to assess the nature of myocardial dysfunction in the cardiac syndrome X (CSX) and insignificant coronary artery disease (ICAD) using dobutamine stress echocardiography (DSE) and coronary calcium scoring (CAC).MethodsWe prospectively studied 35 consecutive patients who complained of exertional angina, had ≥1 mm ST shift on exercise stress test but normal or no obstructive CAD (<50%) on angiography. Patients were divided into CSX (n = 27) with normal arteries and ICAD (n = 8) with insignificant stenosis.ResultsCSX patients had more females, lower calcium score and less prevalent cardiac risk factors compared to ICAD (p < 0.05 for all). At peak stress, MAPSE and TAPSE failed to increase in both groups. LV septal and lateral s’ increased in the two groups but the increment increase was less in CSX than ICAD (p < 0.05) while other diastolic indices did not differ between groups (p > 0.05 for all). CAC correlated modestly with LV an...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2021
Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation o... more Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance ( P <0.001), mono versus 2 vessel disease ( P =0.003), and 2 versus multivessel disease ( P <0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly p...
Aim:The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on ... more Aim:The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.Methods:We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40...
BackgroundThe aim of this study was to investigate the relationship between diabetes mellitus (DM... more BackgroundThe aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).MethodsThis study included 136 consecutive HFrEF patients (65 ± 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e’ ratio / PALS.ResultsAt 55 ± 37 months follow‐up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut‐off value of LASt for predicting CE in the group as a whole was ≥ 0.82% [8...
Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with perc... more Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94...
IntroductionIn responders, cardiac resynchronisation therapy (CRT) results in improved left ventr... more IntroductionIn responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response.Material and methodsWe systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response.ResultsA total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of –5.89% (95% CI: –9.47 to –3.22, p < 0.001). At fo...
European Heart Journal - Cardiovascular Imaging, 2020
Background and Aim Arterial wall strain has been proposed to impact the features of developed pla... more Background and Aim Arterial wall strain has been proposed to impact the features of developed plaques. The aim of this meta-analysis is to assess the impact of different types of wall shear strain (WSS) on the changes of vulnerable plaque in coronary artery disease (CAD). Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, from 1989 up to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and morphology of plaque in CAD. Results In 7 studies, a total of 724 patients with 32,083 segments were recruited, with mean follow up 8.4 months. The pooled analysis showed that low WSS was associated with larger baseline lumen area WMD 2.55 [1.34 to 3.76, p < 0.001], smaller plaque area WMD -1.16 [-0.1.84 to -0.49, p = 0007] and necrotic core area WMD -0.45 [-0.78 to 0.14, p = 0.004], dense calcium score WMD -0.18 [-0.46 t...
European Heart Journal - Cardiovascular Imaging, 2020
Background and Aim Left atrial (LA) stiffness is an important marker of cardiac pump function, es... more Background and Aim Left atrial (LA) stiffness is an important marker of cardiac pump function, especially in patients with heart failure (HF) and preserved ejection fraction (HFpEF). The aim of this study was to evaluate the relationship between LA stiffness and cardiac events (CE) in HF patients with reduced ejection fraction (HFrEF). Methods This study included 136 consecutive HFrEF outpatients (mean age: 65 ± 11 years). A complete conventional and tissue Doppler imaging study was performed. The LA dimension and function were measured. Non invasive LA stiffness was calculated with the following formula: LA stiffness = E/e’ratio/LA strain. The cardiac events were HF hospitalization and cardiac death. Results During a median follow up of 55 ± 37 months, 51 patients had CE, they had higher NYHA functional class (p = 0.001), higher LV end-diastolic dimension (p = 0.001), higher LV end-systolic dimension (p = 0.04), lower EF (p < 0.001), higher E/A ratio (p = 0.01) and reduced TAPSE...
Aims There is good evidence showing that inactivity and walking minimal steps/day increase the ri... more Aims There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality. Methods and results We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81–0.91; P < 0.001], wh...
Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespect... more Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespective of their order and specifics of religious practices. The aim of this study was to assess the cardiac risk factors in Coptic priests and monks and their impact on post-acute COVID-19. Methods: Of 1519 clergy, participating in the COVID-19-Clergy study, serving in Europe and Egypt, 257 had the infection and were included in this analysis. Clergy were divided into priests (n=204) and monks (n=53). Participants&#39; demographic indices, cardiovascular risk factors, management details and post-acute COVID-19 duration were assessed. The impact of geographic differences of life style were also analysed. Results: Priests were more obese (p=0.001), had more type 2 diabetes (DM) (p=0.001), arterial hypertension (AH) (p&lt;0.001), dyslipidemia (p=0.001) and lower prevalence of infection (p&lt;0.001) compared to monks. Their symptoms&#39; duration was more prolonged (p&lt;0.001), had frequent post-acute COVID (p&lt;0.001) and had greater need for hospital treatment (p=0.04). In a sub-analysis, priests serving in Europe had higher prevalence of AH, DM, obesity, CHD, dyslipidemia, longer symptoms duration and more frequent post-acute COVID compared to monks
Left atrial compliance predicts limited exercise in patients with HFpEF and right ventricular dys... more Left atrial compliance predicts limited exercise in patients with HFpEF and right ventricular dysfunction
Background and AimThe aim of this study was to assess the nature of myocardial dysfunction in the... more Background and AimThe aim of this study was to assess the nature of myocardial dysfunction in the cardiac syndrome X (CSX) and insignificant coronary artery disease (ICAD) using dobutamine stress echocardiography (DSE) and coronary calcium scoring (CAC).MethodsWe prospectively studied 35 consecutive patients who complained of exertional angina, had ≥1 mm ST shift on exercise stress test but normal or no obstructive CAD (<50%) on angiography. Patients were divided into CSX (n = 27) with normal arteries and ICAD (n = 8) with insignificant stenosis.ResultsCSX patients had more females, lower calcium score and less prevalent cardiac risk factors compared to ICAD (p < 0.05 for all). At peak stress, MAPSE and TAPSE failed to increase in both groups. LV septal and lateral s’ increased in the two groups but the increment increase was less in CSX than ICAD (p < 0.05) while other diastolic indices did not differ between groups (p > 0.05 for all). CAC correlated modestly with LV an...
Arteriosclerosis, Thrombosis, and Vascular Biology, 2021
Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation o... more Objective: This meta-analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance ( P <0.001), mono versus 2 vessel disease ( P =0.003), and 2 versus multivessel disease ( P <0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly p...
Aim:The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on ... more Aim:The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.Methods:We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40...
BackgroundThe aim of this study was to investigate the relationship between diabetes mellitus (DM... more BackgroundThe aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).MethodsThis study included 136 consecutive HFrEF patients (65 ± 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e’ ratio / PALS.ResultsAt 55 ± 37 months follow‐up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut‐off value of LASt for predicting CE in the group as a whole was ≥ 0.82% [8...
Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with perc... more Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94...
IntroductionIn responders, cardiac resynchronisation therapy (CRT) results in improved left ventr... more IntroductionIn responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response.Material and methodsWe systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response.ResultsA total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of –5.89% (95% CI: –9.47 to –3.22, p < 0.001). At fo...
European Heart Journal - Cardiovascular Imaging, 2020
Background and Aim Arterial wall strain has been proposed to impact the features of developed pla... more Background and Aim Arterial wall strain has been proposed to impact the features of developed plaques. The aim of this meta-analysis is to assess the impact of different types of wall shear strain (WSS) on the changes of vulnerable plaque in coronary artery disease (CAD). Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, from 1989 up to May 2019 in order to select clinical trials and observational studies, which assessed the relationship between WSS measured by intravascular ultrasound (IVUS) and morphology of plaque in CAD. Results In 7 studies, a total of 724 patients with 32,083 segments were recruited, with mean follow up 8.4 months. The pooled analysis showed that low WSS was associated with larger baseline lumen area WMD 2.55 [1.34 to 3.76, p < 0.001], smaller plaque area WMD -1.16 [-0.1.84 to -0.49, p = 0007] and necrotic core area WMD -0.45 [-0.78 to 0.14, p = 0.004], dense calcium score WMD -0.18 [-0.46 t...
European Heart Journal - Cardiovascular Imaging, 2020
Background and Aim Left atrial (LA) stiffness is an important marker of cardiac pump function, es... more Background and Aim Left atrial (LA) stiffness is an important marker of cardiac pump function, especially in patients with heart failure (HF) and preserved ejection fraction (HFpEF). The aim of this study was to evaluate the relationship between LA stiffness and cardiac events (CE) in HF patients with reduced ejection fraction (HFrEF). Methods This study included 136 consecutive HFrEF outpatients (mean age: 65 ± 11 years). A complete conventional and tissue Doppler imaging study was performed. The LA dimension and function were measured. Non invasive LA stiffness was calculated with the following formula: LA stiffness = E/e’ratio/LA strain. The cardiac events were HF hospitalization and cardiac death. Results During a median follow up of 55 ± 37 months, 51 patients had CE, they had higher NYHA functional class (p = 0.001), higher LV end-diastolic dimension (p = 0.001), higher LV end-systolic dimension (p = 0.04), lower EF (p < 0.001), higher E/A ratio (p = 0.01) and reduced TAPSE...
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